Faculdade de Medicina da Universidade do Porto, Portugal.
Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal; Departamento de Medicina da Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Thromb Res. 2023 Oct;230:11-17. doi: 10.1016/j.thromres.2023.08.005. Epub 2023 Aug 11.
Acute pulmonary embolism (PE) can occur as a manifestation of an underlying cancer and be of paraneoplastic aetiology. A previously unknown cancer is sometimes diagnosed after the acute PE diagnosis. The identification of a group of patients with elevated probability of having an occult cancer underlying PE was never performed. We aimed to determine predictors of occult cancer in acute PE. Our hypothesis was that the D-dimer levels would be a predictor of cancer.
We retrospectively analysed a cohort of patients hospitalized with acute PE.
<18 years, venous embolism only of veins other than pulmonary territory or when the embolism was considered chronic, and no image confirmation of acute PE. Patients were grouped according to the timing of cancer diagnosis: 1) known concomitant active cancer, 2) cancer diagnosed during acute PE admission or in the following 2 years and, 3) no known cancer during the 2-year follow-up since PE diagnosis. Predictors of concomitant cancer were determined using a logistic regression analysis. Multivariate models were built.
We studied 562 patients; median age was 72 years and 219 (39.0 %) were men. In 223 (39.7 %) of the patients the PE was of central arteries and 61.4 % presented with bilateral PE. PE was considered unprovoked at time of discharge in 47.7 %. Median (interquartile range) D-dimer level was 7.98 (3.30-14.99) μg/mL. A total of 126 (22.4 %) patients were in group 1, 47 in group 2 (cancer diagnosed after the diagnosis of acute PE and up to 2 years) and 389 patients were in group 3. Elevated D-dimer levels were independently associated with already known cancer. D-dimer were independent predictors of future cancer diagnosis: OR = 1.07 ((95 % CI: 1.01-1.14) per each 5 ng/mL increase; for patients with D-dimer >15.0 μg/mL the OR of future cancer was 2.10 (1.05-4.18). If only patients with unprovoked PE upon admission (n = 307) were to be considered results were similar considering D-dimer; anaemia also predicted unknown cancer [OR = 2.13 (1.08-4.16)].
Patients with D-dimer >15 μg/mL presented a >2-fold higher risk of being diagnosed with a cancer condition in the upcoming 2 years. D-dimer may help clinicians in identifying which patients are at higher risk of occult cancer.
急性肺栓塞 (PE) 可作为潜在癌症的表现，并具有副瘤病因学。有时在急性 PE 诊断后会发现以前未知的癌症。尚未确定一组存在潜在 PE 癌症的可能性较高的患者。我们旨在确定急性 PE 中隐匿性癌症的预测因素。我们的假设是 D-二聚体水平将是癌症的预测指标。
我们回顾性分析了一组因急性 PE 住院的患者。
<18 岁，除肺区静脉外的静脉仅有静脉栓塞或栓塞被认为是慢性的，以及没有急性 PE 的影像学确认。根据癌症诊断时间将患者分为三组：1）同时存在已知活动性癌症，2）在急性 PE 入院期间或入院后 2 年内诊断出癌症，以及 3）在 PE 诊断后的 2 年内无已知癌症。使用逻辑回归分析确定同时存在癌症的预测因素。建立多变量模型。
我们研究了 562 名患者；中位年龄为 72 岁，219 名（39.0%）为男性。在 223 名（39.7%）患者中，PE 为中央动脉，61.4%的患者存在双侧 PE。出院时，47.7%的 PE 被认为是未明确原因的。中位（四分位距）D-二聚体水平为 7.98（3.30-14.99）μg/mL。共有 126 名（22.4%）患者在第 1 组，47 名在第 2 组（在急性 PE 诊断后并在 2 年内诊断出癌症），389 名在第 3 组。较高的 D-二聚体水平与已确诊的癌症独立相关。D-二聚体是未来癌症诊断的独立预测因子：OR=1.07（95%CI：1.01-1.14），每增加 5ng/mL；D-二聚体>15.0μg/mL 的患者未来癌症的 OR 为 2.10（1.05-4.18）。如果仅考虑入院时无明确原因的 PE 患者（n=307），则考虑 D-二聚体时结果相似；贫血也预测了未知癌症[OR=2.13（1.08-4.16）]。
D-二聚体>15μg/mL 的患者在未来 2 年内被诊断为癌症的风险增加 2 倍以上。D-二聚体可帮助临床医生识别哪些患者隐匿性癌症的风险较高。
